BACKGROUND: Chloride has prognostic implications in heart failure (HF). The sodium:chloride (Na:Cl) ratio gathers information of both ions.
OBJECTIVE: To study the prognostic impact of Na:Cl ratio in acute HF.
METHODS: We retrospectively analysed patients included in an acute HF cohort in 2009-2010.
METHODS: all-cause mortality.
RESULTS: 1-year from admission to study the impact of admission Na:Cl ratio; 1-year post-discharge to study the discharge ratio impact. ROC curves of the association of Na, Cl, and the Na:Cl ratio with 1-year mortality were determined and the AUC compared. The association of Na:Cl ratio with mortality was assessed in multivariate analyses.
RESULTS: We studied 616 patients. Median admission Na:Cl ratio = 1.34 (1.31-1.38). During 1-year since admission, 229 patients died, AUC for death-association of admission Na, Cl and Na:Cl ratio = 0.42 (0.38-0.47), 0.39 (0.35-0.44) and 0.58 (0.53-0.63), respectively, with significant difference between Na:Cl ratio curve and the others. When admission Na:Cl ratio ≥ 1.34, the multivariate-adjusted death-risk was 1.41 (1.04-1.89); 1.32 (1.04-1.68), per each 0.1 increase in ratio. In-hospital death rate was 4.1 %, median discharge Na:Cl ratio = 1.40 (1.37-1.45). During 1-year post-discharge, 205 patients (34.9 %) died; AUC for Na, Cl and Na:Cl ratio: 0.45 (0.40-0.50), 0.41 (0.36-0.46) and 0.57 (0.52-0.62), with differences between Na:Cl ratio curve and the others. When discharge Na:Cl ratio ≥ 1.43 (percentile 66.7), the adjusted-HR of death was 1.43 (1.04-1.97), p = 0.03, 1.54 (1.23-1.92) per 0.1 increase.
CONCLUSIONS: Elevated Na:Cl ratio is independently associated with all-cause death. Per each 0.1 increase in Na:Cl ratio at admission and discharged, there was a 32 % and 54 % higher risk, respectively.

BACKGROUND: Hypochloremia has been suggested as a strong marker of mortality in hospitalized patients with heart failure (HF). This study aimed to clarify whether incorporating hypochloremia into pre-existing prognostic models improved the performance of the models.
METHODS: We tested the prognostic value of hypochloremia (<97 mEq/L) measured at discharge in hospitalized patients with HF registered in the REALITY-AHF and NARA-HF studies. The primary outcome was 1-year mortality after discharge.
RESULTS: Among 2496 patients with HF, 316 (12.6 %) had hypochloremia at the time of discharge, and 387 (15.5 %) deaths were observed within 1 year of discharge. The presence of hypochloremia was strongly associated with higher 1-year mortality compared to those without hypochloremia (log-rank: p < 0.001), and this association remained even after adjustment for the Get With the Guideline-HF risk model (GWTG-HF), anemia, New York Heart Association (NYHA) classification, and log-brain natriuretic peptide (BNP) [hazard ratio (HR) 1.64; p < 0.001]. Furthermore, adding hypochloremia to the prediction model composed of GWTG-HF + anemia + NYHA class + log-BNP yielded a numerically larger area under the curve (0.740 vs 0.749; p = 0.059) and significant improvement in net reclassification (0.159, p = 0.010).
CONCLUSIONS: Incorporating the presence of hypochloremia at discharge into pre-existing risk prediction models provides incremental prognostic information for hospitalized patients with HF.

Salinization is an emerging threat in freshwater wetlands, with few techniques available to mitigate anthropogenic inputs such as road salts. Phytoremediation and biochar addition have each been proposed to remediate salt-affected soils generally, but interactive effects in wetland environments to improve soil conditions adjacent to roadways are not well understood. We conducted an 88-day fully factorial greenhouse experiment to quantify the effects of three plant treatments (unvegetated, Typha × glauca and Phragmites australis) and three biochar rates (0.0, 2.5, 5.0 % wt/wt) on the soil and leachate of a simulated wetland system. Both plant species significantly reduced soil Cl- content relative to unvegetated controls, while Typha also significantly reduced Cl- content of leachate and soil Na+. The difference in effects was likely due to different salt tolerance strategies: the salt-accumulating Typha contained a significantly higher volume of Na+, Cl-, and water in its tissue than Phragmites, whose greater K+:Na+ ratio and similar soil Na+ to controls indicated a salt exclusion strategy. Biochar did not influence the growth of either species but moderately increased tissue Na+ concentration in Typha. Furthermore, biochar\'s effects on soil and leachate salt levels varied by application rate with the medium rate moderately increasing soil Na+ and Cl- and leachate Cl-, while the highest application did not differ from controls across all metrics. Our results suggest that phytoremediation can be optimized with salt-accumulating species, whose mechanisms of salt tolerance involve the accumulation of salt ions from the surrounding environment. The consistent flooding in our study may have inhibited the influence of biochar. We recommend future studies parse the effects of water levels and redox potential on biochar\'s ability to influence wetland salinity. Data repository: doi.org/10.17605/OSF.IO/9QFZ7.

Our interest in the design of heavy pnictogen-based Lewis acids for anion trafficking across biological membrane mimics has led us to investigate trivalent bismuthenium cations as chloride anion transporters. Here, we describe two chlorodiarylbismuthines, elaborated on a peri-substituted acenaphthene backbone and stabilized by an adjacent thio- or seleno-ether functionality that engages the bismuth center in a Ch→Bi interaction (Ch = chalcogen). These new derivatives are stable in aqueous environment and readiliy transport chloride anions across the membrane of phospholipid-based vesicles loaded with KCl. In addition to establishing the use of such motifs in anion transport, this investigation shows that the Lewis acidity, lipophilicity, and thus chloride transport properties depend on the nature of the chalcogen.

UNASSIGNED: Chloride plays a crucial role in renal salt sensing. This study investigates whether serum chloride is associated with clinical outcomes and decongestive response to acetazolamide in patients with acute decompensated heart failure.
UNASSIGNED: This post hoc analysis includes all 519 patients from the ADVOR trial (Acetazolamide in Decompensated Heart Failure With Volume Overload), randomized to intravenous acetazolamide or matching placebo on top of intravenous loop diuretics. The impact of baseline serum chloride on the main trial end points and the treatment effect of acetazolamide was assessed, as was the evolution of serum chloride under decongestive treatment.
UNASSIGNED: Hypochloremia (<96 mmol/L) and hyperchloremia (>106 mmol/L) were present in 80 (15%) and 53 (10%), respectively, at baseline. Hypochloremia was associated with significantly slower decongestion, a longer length of hospital stay, and increased risk of all-cause mortality and heart failure readmissions. Acetazolamide increased the odds of successful decongestion and reduced length of stay irrespectively of baseline serum chloride levels. No statistically significant interaction between serum chloride levels and the effect of acetazolamide on death or heart failure readmissions was observed. The placebo group exhibited a progressive decline in serum chloride, which was effectively prevented by acetazolamide (P<0.001).
UNASSIGNED: Hypochloremia is associated with diuretic resistance and worse clinical outcomes. Add-on acetazolamide therapy improves decongestion across the entire range of serum chloride and prevents the drop in chloride levels caused by loop diuretic monotherapy.
UNASSIGNED: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03505788.

The management of nitrogen (N) fertilization is of fundamental importance in hydroponics. To reduce the supply of nitrate (NO3 -) in fertigation recipes for Batavia lettuce crops grown in closed hydroponics, partial replacement of nitrate by chloride (NO3 -/Cl-) at different ratios but with the same equivalent sum was experimentally tested. The experiment included four nutritional treatments in the replenishment nutrient solution, particularly T1; 0.7 mM Cl-/19 mM NO3 -, T2; 2 mM Cl-/17.7 mM NO3 -, T3; 4 mM Cl-/15.7 mM NO3 - and T4; 6 mM Cl-/13.7 mM NO3 -. The results showed that reducing nitrate supply combined with equivalent increase in chloride application gradually reduced the gap between nitrate input and nitrogen uptake concentrations, with the smallest differences occurring in T4 treatment, which reduced the nitrate concentration in the drainage by 50%. The tested treatments led to very small variations in plant water uptake, production of fresh biomass and nutritional quality, which is justified by the proper functioning of key physiological mechanisms, such as stomatal conductance, which was followed by an increased efficiency of nitrogen use up to 25% (kg fresh biomass kg-1 N supply). The steady level of C/N ratio in the plant tissue irrespective of NO3 -/Cl- supply ratio points to sufficiency in photosynthetic products and adequacy in the supply of nitrogen, although leaf Cl- content increased up to 19.6 mg g-1 dry weight in the lowest NO3 -/Cl- treatment. Nutrient uptake concentrations were determined as follows: 13.4 (N), 1.72 (P), 10.2 (K), 3.13 (Ca), 0.86 (Mg, mmol L-1), 27.8 (Fe), 5.63 (Mn), 5.45 (Zn) and 0.72 (Cu, μmol L-1). This study suggests that replacing 30% of NO3 - supply with Cl- in fertigation recipes for hydroponic lettuce crops reduces leaf nitrate content without affecting physiological processes, growth, and quality, verifying in parallel the role of chloride as a beneficial macronutrient. Finally, a relationship between Cl- uptake and its concentration in the root zone solution was established enabling the simulation of chloride to water consumption.

Salt intake reduction is a global concern. In particular, Japanese consume higher amounts of salt than those of other ethnicities. The sodium content is mentioned on the label of industrially prepared dishes with an intention of reducing salt intake. This study aimed to evaluate the difference between the actual sodium content and labeled salt value of industrially prepared Japanese single dishes. Samples labeled \"estimated\" were collected and classified as Japanese, Western, and Chinese cuisines. The sodium content ranged from 180 to 1011 mg/100 g. The sodium content was higher than their reported values in other countries. Specifically, Chinese dishes contained high amounts of sodium, although the chloride content was similar across cuisine styles. Further, the molar ratio (i.e., sodium/chloride) had no significant effect on the difference between the actual content and labeled value. The measured salt contents were 20% higher than the labeled values. The results of decision tree analysis indicated that if the labeled salt value of stir-fried foods is determined by calculation, the actual sodium content is much higher than the labeled salt value. These findings are crucial for customers, dietitian, and researchers as they refer to the labeled salt value to determine the sodium content of industrially prepared foods.

The practical application of Cu(II)-catalyzed Fenton-like reaction (Cu(II)/H2O2) exhibits a low efficiency in the degradation of refractory compounds of wastewater. The impact of chloride ions (Cl-) on Fenton-like reactions have been investigated, but the influence mechanism is still unclear. Herein, the presence of Cl- (5 mM) significantly accelerated the degradation of benzoic acid (BA) under neutral conditions. The degradation of BA follows pseudo-first-order kinetics, with a degradation rate 7.3 times higher than the Cu(II)/H2O2 system. Multiple evidences strongly demonstrated that this reaction enables the production of reactive chlorine species (RCS) rather than HO• and high-valent copper (Cu(III)). The kinetic model revealed that Cl- could shift reactive species from the key intermediate (Cu(III)-chloro complexes) to RCS. Dichlorine radicals (Cl2•-) was discovered to play a crucial role in BA degradation, which was largely overlooked in previous reports. Although the reaction rate of Cl2•- with BA (k = 2.0 × 106 M-1 s-1) is lower than that of other species, its concentration is 10 orders of magnitude higher than that of Cu(III) and HO•. Furthermore, the exceptional efficacy of the Cu(II)/H2O2 system in BA degradation was observed in saline aquatic environments. This work sheds light on the previously unrecognized role of the metal-chloro complexes in production the RCS and water purification.

A significant knowledge gap exists regarding the impact of soil organic matter on the bioavailability of Ag2S-NPs (environmentally relevant forms of Ag-NPs) in soil-earthworm-plant systems. This study used two soils with varying organic matter content, both with and without earthworms, to investigate the bioavailability of Ag2S-NPs. The findings revealed an 80 % increase in Ag bioaccessibility to soybeans in soils with high organic matter content compared to soils with low organic matter. Additionally, the presence of earthworms significantly increased Cl concentrations from 24.3-62.2 mg L-1 to 80.1-147.2 mg L-1, triggering the elevated bioavailability of Ag. Interestingly, Ag2S-NPs eliminated the stimulative effects of earthworms on plant nutrient uptake. In the presence of earthworms, the high organic matter soil amended with Ag2S-NPs exhibited lower concentrations of essential elements (Ca, Cu, Fe, K, and P) in plant tissues compared to soils without earthworms. Our study presents evidence of the transformation of Ag2S-NPs into Ag-NPs across various soil solutions, resulting in the formation of Ag nanoparticle complexes. Particularly noteworthy is the significant reduction in particle sizes in soils incubated with earthworms and high organic matter content, from 85.0 nm to 40.2 nm. Notably, in the rhizosphere soil, a decrease in the relative abundance of nutrient cycling-related phyla was observed, with reductions of 18.5 % for Proteobacteria and 30.0 % for Actinobacteriota. These findings offer valuable insights into the biological and biochemical consequences of Ag2S-NP exposure on earthworm-mediated plant nutrient acquisition.

Elevated levels of atmospheric molecular chlorine (Cl2) have been observed during the daytime in recent field studies in China but could not be explained by the current chlorine chemistry mechanisms in models. Here, we propose a Cl2 formation mechanism initiated by aerosol iron photochemistry to explain daytime Cl2 formation. We implement this mechanism into the GEOS-Chem chemical transport model and investigate its impacts on the atmospheric composition in wintertime North China where high levels of Cl2 as well as aerosol chloride and iron were observed. The new mechanism accounts for more than 90% of surface air Cl2 production in North China and consequently increases the surface air Cl2 abundances by an order of magnitude, improving the model\'s agreement with observed Cl2. The presence of high Cl2 significantly alters the oxidative capacity of the atmosphere, with a factor of 20-40 increase in the chlorine radical concentration and a 20-40% increase in the hydroxyl radical concentration in regions with high aerosol chloride and iron loadings. This results in an increase in surface air ozone by about 10%. This new Cl2 formation mechanism will improve the model simulation capability for reactive chlorine abundances in the regions with high emissions of chlorine and iron.